Monday, December 06, 2010

Massachusetts New Dental Laws and Regulations Have Dentist Concerned

A wonderful letter from a dentist who is very concerned about the state of dentistry in Massachusetts. I hope they don't mind that I shared this.

Dear Debbie, I hope this e-mail finds you and your loved ones in good spirits and good health.

Over here in MA the state dental board passed a host of new dental laws and regulations this past August. While there are a few new laws that at least give a nod towards promoting public safety, when I read many of the laws, I saw many regulations written with dollar signs in mind.

Three of the laws (Public health center, dental director, and public health hygienist laws.) will further entrench the unscrupulous Medicaid mills already present in this state. On top of this horror, a host of sedation laws will allow dentists to be, for all intents and purposes, anesthesiologists.

Deep sedation, whether one is working on the heart or in the mouth, functions the same in both patient populations. In other words, although the specific purposes are different (heart surgery vs dental work), the physiological mechanism is the same, and the risks are the same. Unfortunately, these risks involve death and/or brain damage.

Where things are now different in this state, and where things have gone horrifyingly awry, is that with a brief (and expensive, of course.) period of training, some of my colleagues will be able to place patients under deep sedation. In medicine, MD anesthesiologists and nurse anesthesiologists must go through a rigorous residency program lasting for years. (4 years for MDs and 2 years for nurse anesthesiologist practitioners.)

On a functional level, medicine has recognized that it is better to have a specifically-trained person in a proper setting to perform anesthesia. Medicine recognizes that it's not a good idea for the surgeon to try to sedate the patient, monitor the patient's life signs and breathing, and also perform surgery. The only "positive" side to this hypothetical medical scenario is that the surgeon could make out like a bandit by doing everything him/herself.

Debbie, my deep and abiding fear is the day when the new dental mill-enabling laws in this state converge with the new sedation laws in this state. Imagine what Small Smiles would do with a state-sanctioned sedation carte blanche. Now, it's only a matter of time before the carnage starts. Kids shouldn't die for the profit margins of the ruthless. Goddamn them. Please be well Debbie. Sincerely,